MX2007003513A - Cooling device having a plurality of controllable cooling elements to provide a predetermined cooling profile - Google Patents

Abstract

A cooling device for removing heat from subcutaneous lipid-rich cells of a subject having skin is provided. The cooling device includes a plurality of cooling elements movable relative to each other to conform to the contour's of the subject's skin. The cooling elements have a plurality of controllable thermoelectric coolers. The cooling elements can be controlled to provide a time-varying cooling profile in a predetermined sequence, can be controlled to provide a spatial cooling profile in a selected pattern, or can be adjusted to maintain constant process parameters, or can be controlled to provide a combination thereof.

Description

COOLING DEVICE WHICH HAS A PLURALITY OF CONTROLLING COOLING ELEMENTS TO PROVIDE A PREDETERMINED COOLING PROFILE CROSS REFERENCE TO RELATED APPLICATIONS This application claims the benefit of US Patent Application No. 11 / 528,225, filed on September 26, 2006, and entitled "COOLING DEVICE THAT HAS A PLURALITY OF COMBINED COOLING ELEMENTS TO PROVIDE A PREDETERMINED COOLING PROFILE", which is incorporated herein by reference.

TECHNICAL FIELD The present application relates generally to cooling devices, systems and methods for removing heat from subcutaneous lipid-rich cells, and more particularly, but not exclusively, to a cooling device having a plurality of controllable cooling elements to create a profile of spatial cooling and / or a variable time cooling profile in order to more efficiently affect cells rich in subcutaneous lipids.

ANTECENT Excess body fat increases the likelihood of developing various types of diseases such as heart disease, high blood pressure, osteoarthrosis, bronchitis, hypertension, diabetes, deep vein thrombosis, pulmonary embolism, varicose veins, gallstones, hernias, and other severe conditions. In addition to being a serious health risk, too much body fat can also diminish personal appearance and athletic performance. For example, excess body fat can form cellulite, which causes an "orange peel" effect on the surface of the skin. Cellulite is formed when subcutaneous fat protrudes into the dermis and creates dimples where the skin joins important structural fibrous filaments. Cellulite and excessive amounts of fat are often considered unattractive. Thus, in view of the serious health risks and aesthetic issues associated with excess fat, an effective way to control the accumulation of excess body fat is urgently needed. Liposuction is a method to selectively remove body fat to sculpt the body of the person. Liposuction is typically performed by plastic surgeons and dermatologists who use specialized surgical equipment that mechanically removes subcutaneous fat cells through suction. A disadvantage of liposuction is that a serious surgical procedure, and recovery can be painful. Liposuction can have serious and occasionally even fatal complications. In addition, the cost for liposuction is usually substantial. Conventional non-invasive treatments for removing excess body fat typically include topical agents, weight loss drugs, regular exercise, diet, or a combination of these treatments. A disadvantage of these treatments is that they may not be effective or even possible under certain circumstances. For example, when a person is hurt or physically ill, regular exercise can not be an option. Similarly, weight loss drugs or topical agents are not an option when they cause an allergy or negative reaction. In addition, the loss of fat in selective areas of a person's body can not be achieved by using general methods or systematic weight loss. Other non-invasive treatment methods include applying heat to a zone of subcutaneous lipid-rich cells. The US Patent No. 5,948,011 discloses altering subcutaneous body fat and / or collagen by heating the subcutaneous fat layer with radiant energy while cooling the surface of the skin. The applied heat denatures the fibrous septum made of collagen tissue and can destroy fat cells under the skin, and cooling protects the epidermis from thermal damage. This method is less invasive than liposuction, but can even cause thermal damage to tissue adjacent, and it can be painful for the patient. Another method for reducing subcutaneous fat cells is to cool the target cells as described in U.S. Patent Publication No. 2003/0220674, the full disclosure is incorporated herein. This publication describes, among other things, reducing the temperature of lipid-rich subcutaneous fat cells that selectively affect fat cells without damaging the cells in the epidermis. Although this publication provides promising methods and devices, several improvements would be desirable to increase the implementation of these methods and devices, including providing a plurality of controllable cooling elements to create a spatial cooling profile and / or a variable time cooling profile with In order to more efficiently affect lipid-rich cells. U.S. Patent Publication No. 2003/0220674 also describes methods for selective removal of lipid-rich cells and prevention of damage to other structures including dermal and epidemic cells. A method to control these effects more efficiently and precisely is desirable. Therefore, a method for spatially cooling lipid rich cells in a predetermined variable time cooler profile, selected spatial cooling profile, or maintaining constant process parameters is also needed.

BRIEF DESCRIPTION OF THE DRAWINGS In the drawings, identical reference numbers identify similar elements or acts. The relative sizes and positions of elements in the drawings are not necessarily drawn to scale. For example, the shapes of various elements and angles are not drawn to scale, and some of these elements are arbitrarily lengthened and placed to improve the readability of drawings. Furthermore, the particular shapes of the elements as drawn are not intended to convey any information with respect to the actual shape of the particular elements, and were only selected for ease of recognition in the drawings. Figure 1 is an isometric view of a system for removing heat from cells rich in subcutaneous lipids according to one embodiment of the invention. Figures 2A, 2B, 2C, and 2D are isometric views of a cooling device for removing heat from cells rich in subcutaneous lipids according to embodiments of the invention. Figure 3 is an exploded isometric view of the cooling device of Figure 2A for removing heat from rich cells and subcutaneous lipids according to one embodiment of the invention.

Figure 4 is another exploded isometric view of the cooling device of Figure 3 illustrating additional components of the cooling device according to another embodiment of the invention.

Figure 5A is an isometric view of a plurality of heat exchangers connected in series according to another embodiment of the invention. Figure 5B is an isometric top view of a plurality of heat exchangers connected in series according to even another embodiment of the invention. Figure 5C is an isometric bottom view of the heat exchangers in Figure 5B. Figure 6A is an exploded isometric view of one of the heat exchangers shown in Figure 5A. Figure 6B is an isometric view of an alternative configuration of a cooling element of a heat exchanger according to an embodiment of the invention. Figure 7 is a cross-sectional view of one of the cooling elements along line 7-7 of Figure 5A. Figure 8 is an isometric top view of an alternative cooling device for removing heat from subcutaneous lipid rich cells according to one embodiment of the invention. Figure 9 is an isometric bottom view of the alternative cooling device of Figure 8. Figure 10 is an illustrative cross-sectional view of a lateral cooling pattern in the dermis of the skin according to another embodiment of the invention. Figure 11 is a block diagram showing computer system software modules for removing heat from cells rich in subcutaneous lipids according to another embodiment of the present invention. invention.

DETAILED DESCRIPTION A. General Information The present disclosure describes devices, systems, and methods for cells rich in subcutaneous cooling lipids. The term "subcutaneous tissue" means tissue that lies under the dermis and includes adipocytes (fat cells) and subcutaneous fats. It will be appreciated that several of the details mentioned below are provided to describe the following embodiments in a manner sufficient to enable one skilled in the art to make and use the described modalities. Several of the details and advantages described below, however, may not be necessary to practice certain embodiments of the invention. Additionally, the invention may include other embodiments that are within the scope of the claims but are not necessarily described in detail with respect to Figures 1-11. Reference throughout this specification to "one modality" or "modality" means that a particular signal, structure, or feature described in connection with the embodiment is included in at least one embodiment of the present invention. In this way, the occurrences of the phrases "in one modality" or "in the modality" and several places through this specification do not necessarily refer to this modality. In addition, the signs, structures, or Particular features can be combined in any suitable form in one or more modalities. The headings provided here are for convenience only and do not interpret the scope or meaning of the claimed invention. The present invention is directed to a cooling device for removing heat from subcutaneous lipid-rich cells of a subject. The cooling device includes a plurality of cooling elements that move in relation to one another to be comfortable for the subject's skin. One aspect is directed towards a cooling device to remove heat from cells rich in subcutaneous lipids. The cooling device includes a plurality of cooling elements contained within the interconnected frame members that rotate on at least one axis, a plurality of heat exchange elements, and a housing. Alternatively, the cooling device includes a plurality of cooling elements contained in a flexible substrate. The cooling elements may use a number of cooling technology including, for example, thermoelectric coolers, recirculating frozen fluid, vapor compression elements, or cryogenic phase change devices. One skilled in the art will recognize that there is a number of other cooling technologies that can be used and that the cooling elements need not be limited to those described herein.

Another aspect is directed to a cooling device having a plurality of cooling members using Thermoelectric Peltier principles or other cooling technologies. The cooling device also includes a heat dissipation member in thermal communication with the cooling members and a plurality of interface members having heat exchange surfaces configured to contact the skin of the subject. The cooling members may be able to reduce a temperature of a region so that the lipid-rich cells in the region are affected, while the non-lipid-rich cells are generally not affected. Other aspects include that the cooling device may include a plurality of hinged segments interconnected to rotate to form a body portion. Alternatively, the cooling elements may be arranged on a flexible substrate and move in relation to one another. Another aspect is directed towards a cooling device having a plurality of individually controlled cooling members to provide a spatial cooling profile and / or a variable time cooling profile. The cooling profile may, for example, be configured to provide cooling members along a perimeter of the cooling device at a temperature lower or higher than that of the cooling members within the interior of the cooling device. 1 or cooling. Alternatively, the cooling profile may be configured to provide cooling members in regions of the cooling device at a temperature lower or higher than that of the cooling members in adjacent regions of the cooling device. Other aspects include that the cooling profile may vary over time to provide a decreasing or increasing temperature profile during treatment.

Another aspect is directed to a method for applying a cooling device having a plurality of cooling elements contained in a plurality of interconnected hinged elements, each adjacent or hinged cooling elements can rotate on at least one axis. The cooling elements may have a plurality of heat exchange surfaces capable of removing heat from the skin of the subject. The method includes rotating hinged segments containing the cooling elements to achieve a desired configuration of the cooling device, cooling the heat exchange surface of the plurality of cooling elements to a desired temperature, placing the plurality of heat exchange surface cooled down near the skin of the subject, and reduce the temperature of a region so that the. Lipid-rich cells in the region are affected while cells not rich in lipids in the region are generally not affected. Alternatively, the cooling elements can be arranged on a flexible substrate and moved in relation to one another.

Other aspects include a method to apply and maintain pressure in the contact region. Other aspects include securing the cooling device in position with a holding device. Other aspects include providing a variable time profile to increase or decrease the temperature of the cooling elements in a selected period of time. Other aspects include spatially varying the temperature of each cooling element of the cooling device to provide separate cooling regions in the cooling device. Another aspect is directed towards a system to remove heat from cells rich in subcutaneous lipids. The system includes a cooling device having a plurality of frame segments containing cooling elements that move in relation to each other, the frame segments capable of achieving a desired orientation between one another, and a coupled heat depression. to the cooling device to dissipate heat generated by the cooling device. In one embodiment, the frame segments are hinged. When placed close to the skin of the subject, the plurality of cooling elements is capable of reproducing a temperature of a region so that the lipid-rich cells are affected while the non-lipid-rich cells in the epidermis and / or the dermis are generally not affect Other aspects include the cooling device configured to follow the contours of the body. Other aspects includes that the cooling device includes a control and / or may include a strap or other holding device to maintain the cooling device in a selected position. Other aspects include a control system for individually controlling the temperature of the cooling elements in a predetermined pattern. Other aspects include a processing unit for controlling a variable time cooling profile of the cooling device.

B. System for Selectively Reducing Lipid Rich Cells Figure 1 is an isometric view of a system 100 for removing heat from subcutaneous lipid rich cells of a subject 101 according to one embodiment of the invention. The system 100 may include a cooling device 104 placed in an abdominal areas 102 of subject 101 or other suitable area for removing heat from the subcutaneous lipid-rich cells of subject 101. Various embodiments of cooling device 104 are described in more detail below with reference to Figures 2-11. The system 100 may further include a cooling unit 106 for supplying and returning fluid lines 108 ab connecting the cooling device 104 to the cooling unit 106. The cooling unit 106 can remove heat from a cooler to a heat sink and provide a cooler frozen to the cooling device 104 through the fluid lines 108 a-b. Examples of the circulating cooler include water, glycol, synthetic heat transfer fluid, oil, a coolant, and any other suitable heat conducting fluid. The fluid lines 108 a-b may be hoses or other conduits constructed of polyethylene, polyvinyl chloride, polyurethane, and other materials that can accommodate the particular circulation chilled. The cooling unit 106 can be a cooling unit, a cooling tower, a thermoelectric freezer, or any other device capable of removing heat from a cooler. Alternatively, a municipal water supply (ie, local water supply) can be used in place of the cooling unit. As explained in detail below, the cooling device 104 includes a plurality of thermoelectric cooling elements, such as Peltier-type thermoelectric elements, which can be individually controlled to create a spatial cooling profile of customs and / or a profile of variable time cooling. The system 100 may further include a power supply 110 and a processing unit 114 operatively coupled to the cooling device 104. In one embodiment, the power supply 110 may provide a direct current voltage to the thermoelectric cooling device 104 to effect a removal rate of the subject 101. The processing unit 114 can verify process parameters through sensors (not shown) positioned near the cooling device 104 through line 116 to adjust the heat removal rate based on the process parameters. The heat transfer rate can be adjusted to maintain constant process parameters. Alternatively, the process parameters may vary either spatially or temporally. The processing unit 114 may be in direct electrical communication through the line 112, or alternatively, it may be connected through a wireless communication. Alternatively, the processing unit 114 may be programmed to provide a spatially distributed cooling profile and / or a variable time cooling profile. The processing unit 114 may include any processor, Programmable Logic Control, Distributed Control System, and the like. In another aspect, the processing unit 114 may be in electrical communication with an input device 118, an output device 120, and / or a control panel 122. The input device 118 may include a keyboard, a mouse, a touch-sensitive screen, a push button, a switch, a potentiometer, and any other suitable device to accept user input. The output device 120 may include a display screen, a printer, a media reader, an audio device, and any other suitable device to provide user feedback. The control panel 122 It may include indicator lights, numerical presentations, and audio devices. In alternative embodiments, the control panel 122 can be understood in the cooling device 104. In the embodiment shown in Figure 1, the processing unit 114, supplies power 110, control panel 122, cooling unit 106, input device 118, and output device 120 is transported by a course 124 with wheels 126 for portable capacity. In alternative embodiments, the processing unit 114 may be contained in the cooling device 104. In another embodiment, the various components may be fixedly installed in a treatment site.

C. Cooling Devices Having a Plurality of Cooling Elements Figures 2A, 2B, and 2C are isometric views of a cooling device 104 according to embodiments of the invention suitable for use of the system 100. In this embodiment, the cooling device 104 includes a housing of the control system 202 and housing of cooling elements 204 a-g. The housing of the control system 202 includes a sleeve 308 (Figure 3) that can slide on the collar 310 and / or can be mechanically attached to the cooling element housings. The cooling housings 204 a-g are connected to the heat exchange elements (not shown) by means of connection 206. The joining means can be any mechanical joining device such as a screw or snap as is known in the art. The plurality of cooling element housings 204 a-g can have many similar characteristics. As such, the characteristics of the first cooling element housing 204a are described below with reference to symbols followed by an "a", which correspond to characteristics of the second cooling element housing 204b are shown and noted by the same reference symbol followed by a "b", and so on. The cooling element housing 204a may be constructed of polymeric materials, metals, ceramics, woods, and / or other suitable materials. The example of cooling element housing 204a shown in Figure 2A-C is generally rectangular, but may have any other desired shape. The cooling device 104 is shown in a first relatively flat configuration in Figure 2A; in a second slightly curved configuration in Figure 2B; and in a third curved configuration in Figure 2C. As shown in Figures 2B and 2C, each segment of the cooling element housings 204a-g rotatably connect to adjacent segments and move over the connection 207a-f to allow the cooling device 104 to bend. The connection 207a-f, for example, can be a snap, a ball joint, a support, or other type of rotatable joints. In connection 207 it can therefore be configured to rotatably engage the first cooling element housing 204a to second cooling element housing 204b. According to aspects of the invention, the first cooling element housing 204a can rotate relative to the second cooling element housing 204b (indicated by the arrow A), each adjacent movable pair of cooling elements being such that, for example, the angle between the first and second cooling element housings 204a and 204b can be adjusted up to 45 °. In this way, the cooling device is articulated so that it can assume a curved configuration as shown in Figure 2B or 2C, comfortable for the skin of a subject. An advantage of the plurality of rotatable heat exchange surface is that the arcuate shape of the cooling device can concentrate the heat transfer in the subcutaneous region. For example, when heat exchange surfaces rotate about a body contour of a subject, the arcuate shape may concentrate heat removal from the skin. The control system housing 202 can house a processing unit for controlling the cooling device 104 and / or fluid lines 108a-b and / or electrical power and communication lines. The control system housing 202 includes a harness port 210 for electrical and supply fluid lines (not shown for clarity purposes). The housing of the control system 202 can also be configured to serve as a control for a user of the cooling device 104.

Alternatively, the processing unit may be contained in a location other than the cooling device. As shown in Figures 2A, 2B, and 2C, the cooling device 104 may further include at each end of the cooling device 104 retention devices 208a and 208b coupled to a frame 304. The retention devices 208a and 208b are connected rotatably to the frame through the retaining device coupling elements 212a-b. The coupling elements of the retaining device 212a-b, for example, can be a snap, a ball joint, a support or other type of rotatable joints. Alternatively, the retaining devices 208a and 208b can be fixed securely to the end portions of the cooling element housings 204a and 204g. Alternatively, the retaining device can be attached to the control system housing 202. The retaining devices 208a and 208b each are shown as tabs 214, each having a slot 216 therein for receiving an enlastomeric band or strap (not shown for of clarity) to retain the cooling device 104 in place in a subject 101 during treatment. Alternatively, the cooling device may not contain any attached retaining device and may be held in place by hand, held in place by gravity, or may be held in place with a band, elastomeric strap, non-elastic fabric (e.g. , nylon woven belt) entangled around the cooling device 104 and subject 101. As shown in Figures 2A-2C, the cooling element housings 204a-g have a first edge 218 and a second adjacent edge 220 of a reciprocal shape to allow the cooling device 104 is coupled and, thus, configured in the flat configuration. The first edge 218 and the second edge 220 are generally angular in the Figures; however, the shape could be curved, straight, or a combination of angles, curves, and straight edges that provide a reciprocal shape between adjacent segments of the cooling element housings 204a-g. Figure 2D shows an isometric view of an alternative cooling device 104 according to embodiments of the invention suitable for use in the system 100. In this embodiment, the cooling device 104 includes a plurality of heat exchange elements 300a-g contained within a flexible substrate 350. As described with respect to Figures 2A-2C, the adjacent heat exchange elements 300a-g are coupled in fluid form in series by fluid lines 328. According to aspects of the modality , the cooling elements 302a-g can be fixed to the flexible substrate 350, or can be fixed to the flexible substrate 350. the flexible substrate 350 can be constructed of polymeric materials, elastomeric materials, and / or other suitable materials. The flexible substrate 350 may furthermore be an elastomer such as silicone or urethane or It can be a fabric, such as nylon. The flexible substrate 350 can also be a thin polymer such as polypropylene or ABS. The example of the flexible substrate 350 shown in Figure 2D is generally rectangular, it can have any other desired shape, which includes a matrix configuration or a specific form of anatomy. In accordance with aspects of this embodiment, the flexible substrate 350 acts as a live hinge between cooling elements 302a-g to allow the cooling elements 302a-g to form the skin of a subject. Figure 3 is an exploded isometric view of a cooling device 104 according to an embodiment of the invention suitable for use in the system 100. In this embodiment, the cooling device 104 includes a frame 304 having a plurality of segments rotatably connected 305a-g. The rotatably connected segments 305a-g are connected by hinges 306a-g. Alternatively, the rotatably connected segments 305a-g of the frame 304 could be connected by a connection allowing rotation, such as a snap, live hinge, flexible substrate, such as a woven belt or cloth, or the like. According to one aspect of the invention, the links can be made of plastic to isolate the cooling elements from one another. A plurality of heat exchange elements 300a-g is contained in the frame 304. The heat exchange elements 300a-g include cooling elements 302a-g having covers 301a-g. The covers 301a-g are fixed on an upper side of the cooling elements 302a-g. The covers 301a-g can be fixed by various mechanical means as described further here and as shown in the art. In accordance with aspects of the invention, covers 301a-g are fluidly sealed to cooling elements 302a-g. according to other aspects of the invention, the hinges 306a-g are configured to be adjacent to the skin of the subject, in use, to understand closeness between the heat exchange elements 300a-g when the heat exchange elements 300a- g are in a rotated position. The cooling elements 302a-g are joined by the cooling element attachment means 307 to the frame 304 so that the first heat exchange element 300a is located in the first segment 305a of the frame 304 and the second heat exchange element 300b is located in the second segment 305b of the frame 304. The cooling element attaching means 307 is shown as a tongue 313 extending from the frame 304 and a fixing screw 315 attached to the tongue 313 of the frame 304 to the frame elements 304. cooling 302a-g. Alternatively, mechanical fastening devices as are known in the art can be used. The cooling elements 302a-g of the cooling device 104 are generally configured to rotate to allow the cooling device 104 to form an arcuate portion of a subject 101. Once placed on a subject 101, the device cooling element 104 may further be attached or otherwise configured to releasably attach to a subject 101. Cooling elements 302a-g may be configured to move in relation to each other or rotate to the position of cooling elements 302a-g to apply pressure to the treatment area during operation. The cooling elements 302a-g move or rotate in relation to each other so that the cooling device 104 is comfortable for the skin of the subject. These features are described in more detail below with reference to specific examples of cooling devices. The first cooling element 302a may include in the cooling element housing 204a, a fluid inlet port 310 and a fluid outlet port 316a. The fluid inlet port 310 is fluidly coupled to the supply fluid line 108a. as shown in Figure 3, the adjacent cooling elements are fluidly coupled in series by lines 328 in fluid inlet ports 314a-f and fluid outlet ports 316a-f. The cooling element 302g further includes a fluid outlet port 312 fluidly coupled to the return fluid line 108b. An expected advantage for providing fluidly coupled cooling elements in series is a uniform flow rate through each cooling element 302a-g to provide more consistent cooling of the cooling device. cooling. Another expected benefit of providing cooling elements 302a-g fluidly coupled in series is fewer supply lines in the cooling device to provide a more reliable fluid flow configuration, less difficult to handle, and easier to house for the device. cooling. Figure 4 is another exploded isometric view of the cooling device of Figure 3 according to an example of the invention for use in the system 100. This other exploded view is substantially similar to the previously described examples, and acts are identified commons and structures by the same reference numbers. Only significant differences in operation and structure are described below. The cooling device 104 includes cooling elements 302a-g having a plurality of thermoelectric coolers 402 configured to reduce the temperature of a subcutaneous region of the subject 101 to selectively affect lipid-rich cells in the region. The plurality of thermoelectric chillers 402, also known as a Peltier type element, has a first side 404 and a second side 406. The first side 404 is in thermal communication with the cooling element 302, and the second side 406 is in thermal communication with an interface member 418. The thermoelectric coolers 402 can be connected to an external power supply (not shown) to transfer heat between the first side 404 and the second side 406. A suitable thermoelectric cooler is a cooling element of the type Peltier (model # CP-2895) produced by TE Technologies, Inc. in Trverse City, Michigan. The thermoelectric chillers 402 are contained within the segments 305a-g of the frame 304. According to aspects of the invention, the frame 304 may contain individual guides for each chiller and thermoelectric 402. Alternatively, the thermoelectric chillers 402 may be retained in elements of cooling 302a-g, for example, by epoxy-thermal or by a combination of welding, mechanical compression and thermal grease. As shown in Figure 4, the plurality of cooling elements 302a-g may further include a plurality of interface members 418 in thermal communication with the thermoelectric cooler 402 having heat exchange surfaces 420 for transferring heat to / from the subject 101. In one example, the interface 418 members are generally flat, but in other examples, the interface members 418 are not flat (for example, curved, faceted, etc.). The interface members 418 can be constructed of any suitable material with a thermal conductivity greater than 0.5 Watts / Meter Kelvin, and in many examples, the thermal conductivity is greater than 0.1 Watts / Meter Kelvin. Examples of suitable materials include aluminum, other metals, metal alloys, graphite, ceramics, some polymeric materials, composite materials, or fluids contained in a flexible membrane. When applying power to the thermoelectric chillers 402, the heat can be effectively removed from the skin subject to a fluid circulating in cooling elements 302a-g. For example, applying a current to the thermoelectric chillers 402 can achieve a generally low temperature of 37 ° C on the first side 404 of the thermoelectric chillers 402 to remove heat from the subject 101 through the interface members 418. The thermoelectric chillers 402 pull heat from the second side 406 to the first side 404 where the heat is then transferred to the circulating fluid. The cooling unit 106 is then removed from the circulating fluid heat. The thermoelectric coolers 402 can be configured to withdraw a sufficient amount of heat rapidly from the subject 101 without using a high current power supply for the cooling unit 106. In order to facilitate thermal transfer, the interface members 418 can be a plate of aluminum generally configured to the same dimensions in the thermoelectric coolers 402. According to aspects of the invention, the thermoelectric coolers 402 can be Peltier-type thermoelectric elements measured approximately 160 Watts. As such, the cooling device 104 can cool a portion of the subject's skin from a temperature of about 37 ° C to about -20 ° C quickly and efficiently. The cooling unit 106 can utilize a normal voltage power supply (e.g., 120 VAC) because the power consumption is not excessive. This allows the system to be used in hospitals, clinics, and small offices without expensive high-voltage electrical systems. Figure 5A is an isometric view of a plurality of heat exchange elements 300a-g connected in series with the housing removed to better show the plurality of heat exchange elements 300a-g and interconnected fluid lines. In accordance with aspects of the invention, the heat exchange elements 300a-g are rotatably contained in linked segments of the frame 304 to provide a cooling device that is wider than its height. In this way, the cooling device is condescending and will be formed to follow contour. According to aspects of the invention, the cooling device is small in dimension in a first dimension so that the curvature of the treatment area in a second dimension does not significantly impact the amount of surface area in contact between the skin and the device. cooling. According to other embodiments of the invention, Figure 5B is an isometric top view of a plurality of heat exchangers connected in series through hinges 350a, 350b, wherein the hinge connection is directly connected to the heat exchanger 302a, 302b. The hinge 350a, 350b as shown in Figure 5B is a piano hinge extending along adjacent edges of the heat exchanger 300a, 300b for the length of the heat exchanger 300a, 300b, alternatively, the hinge 350a, 350b can extending a portion of the length of the adjacent sides of the heat exchanger 300a, 300b or the hinged connection may include a plurality of hinges 350a, 350b. Different from Figure 5A, no frame is used to connect the heat exchangers 300a, 300b or provide support for the hinged connection between heat exchangers 300a, 300b. Figure 5C is an isometric bottom view of the heat exchangers in Figure 5B. In accordance with other aspects of the invention, the alternative hinged mechanical connections as known in the art can be used alone or in combination; or, alternative chemical connections such as flexible adhesives or a live hinge as known in the art can be used in hinged connections; or, electromechanical connections such as magnets can be used between heat exchangers to connect the heat exchangers. Figure 6A is an exploded isometric side elevation view of the heat exchange element 300a shown in Figure 5A to further show the flow of fluid in the heat exchanger element 300a. Similar reference symbols refer to similar features and components in the Figures. As shown in Figure 6A, the heat exchange element 300a may include a fluid chamber 610 having a serpentine shape inside the cooling element 302a. As shown in Figure 6B, the heat exchange element 300a may include fins 612 for directing fluid flow through the fluid chamber 610. The fluid chamber 610 may be in fluid communication with the associated fluid ports so that fluid can flow through the fluid chamber 610. The fluid chamber 610 can be configured to accept fluid coolers, such as water, glycol, a synthetic heat transfer fluid , oil, refrigerants, air, carbon dioxide, nitrogen, and argon. In accordance with other aspects of the invention, the fluid chamber 610 can be configured in a variety of configurations as is known in the art in order to distribute the fluid through the cooling element 302a. Figure 7 is a cross-sectional view of a cooling element 302a. The cooling element 302a is fluidly sealed by the cover 301a containing a ring seal or 722, held in place by a joining means 326. According to aspects of the invention, the cooling element 302a may further include at least a perception element 710 near the heat exchange surface 420 (Figure 4). The sensing element 710, for example, can generally flow with the heat exchange surface 420. Alternatively, it can be recessed or protruded from the surface. The sensing element 710 may include a temperature sensor, a pressure sensor, a transmission sensor, a bio resistance sensor, an ultrasound sensor, an optical sensor, an infrared sensor, a heat flow sensor, or any other of the desired sensors as described hereinafter. In one example, the perception element 710 can a sensor of temperature configured to measure the temperature of the first heat exchange surface 420 and / or the skin temperature of the subject 101. For example, the temperature sensor may be configured as a probe or as a needle penetrating the skin during measurement . Examples of suitable temperature sensors include thermocouples, resistance temperature devices, thermometers (e.g., germanium thermistors calculated from neutron transmutation), and infrared radiation temperature sensors. In another example, the sensing element 710 may be an ultrasound sensor configured to measure catalysis or change in viscosity of subcutaneous fat in the treatment region of a subject. In yet another example, the sensing element 710 may be an optical or infrared sensor configured to verify an image of the treatment region to detect, for example, epidermal physiological reactions for treatment. The perception element 710 may be in electrical communication with the processing unit 114 through, for example, a direct connection, a network connection and / or a wireless connection. Accordingly, the cooling device 104 may be in electrical communication with the processing unit 114, and the cooling temperature must be automatically adjusted by the processing unit 114. In accordance with other aspects of the invention, the temperature of the member of the cooling unit is in accordance with the invention. interface 418 can be perceived by the perception element 710 and the electrical signal perceived may be converted by processing unit 114 to a process value for temperature. In one embodiment, the processing unit 114 may include a proportional, integral and derivative controller, which may be adjusted to the energy output so that the thermoelectric chillers 402 achieve and / or maintain the desired temperature. According to other aspects of the invention, the sensing element 710 can alternatively be a pressure sensor for sensing the pressure exerted by the cooling element 302a against the subject 101. In one embodiment, the interface member 418 can be attached to the frame 304 so that such pressure applied against the applied heat element 300a is transferred through the housing 204a to the pressure sensor. The pressure sensor can alternatively be configured to sense the pressure in the fluid chamber 610 to verify pressure variations in the fluid chamber 610. Alternatively, the pressure could be inferred in the force and in the known contact area of the cooling elements. For example, the sensing element 710 can be any type of charge sensitive pressure sensing element such as a load cell (model # LC201-25) produced by OMEGA Engineering, Inc. in Stamford, Connecticut. The direct pressure measurement could also be made by placing a pressure measuring membrane directly on the interface between the cooling element and the skin. Cooling elements 302a-g can have many additional modalities with different and / or additional characteristics without diminishing the operation of the elements. For example, an adjacent cooling element may or may not have a sensing element near the heat exchange surface. Alternatively, the cooling elements can be constructed of a material that is different from that of the adjacent cooling element. Figure 8 shows an isometric view of a plurality of thermoelectric coolers with a matrix design. Figures 8 and 9 are isometric views of an alternative cooling device for removing heat from cells rich in subcutaneous lipids according to one embodiment of the invention. As shown in Figures 8 and 9, the cooling device 810 includes a cooling element 804 configured in a planar array. The cooling device 810 may include a band 812 for retaining the cooling element 804 in place during use. The cooling device may further include a control 814, a harness via cables 818 and a flap 816 to releasably secure the band 812 to the cooling element 804. The cooling element 804 may further include a sleeve 822 as described above. . As shown in Figure 9, the cooling element 804 includes a flat die 824 that includes a plurality of thermoelectric coolers 826. The thermoelectric coolers 826 are contained in a flexible substrate 830. The flexible substrate 830 can be an elastomer such as a silicone or urethane or it can be a fabric, such as nylon. According to other aspects, the flexible substrate 830 can be a thin polymer such as polypropylene or ABS. As described in more detail here, the thermoelectric coolers 826 may have small protective interface plates (not shown) glued to the cold surface of the thermoelectric coolers 826 with a thermal epoxy. According to alternative embodiments of the invention, mechanical limitations can further be included in the flexible substrate 830 for capturing the thermoelectric coolers 826. As described herein in more detail, the thermoelectric coolers 826 may include a heat exchanger (shown and described with with respect to Figures 3-7) on the hot side to cool the hot side. In accordance with aspect of this embodiment, each thermoelectric cooler 826 may have a corresponding heat exchanger to provide increased flexibility to the planar array. Alternatively, an individual flexible heat exchanger may be coupled to the hot side of the thermoelectric coolers (eg, a bag or other flexible membrane in which the water can circulate). According to alternative aspects of the mode, the flat die 824 may further include temperature sensors or others (not shown) captured between the inferio plate and the thermoelectric coolers and / or may have a separate sleeve which houses temperature sensors as well as It is discussed here.

D. Operation of the Cooling Device Figure 10 is an illustrative cross-sectional view of a lateral cooling pattern in the dermis of the skin. The cooling pattern radiates from the cooling elements 302a-fa through the epidermis and dermis of the skin so that when they affect the target dermis layer containing the lipid-rich cells, the cooling pattern forms a uniform cooling layer and Any space between the segments of the frame can be mitigated. An expected benefit of this cooling pattern is that the cooling of the dermis layer uniform during treatment. Figure 10 describes the cooling device 104 applied to a generally planar portion of the body of a subject. Cooling elements 302a-f of the cooling device move relative to each other (as shown in Figures 2B), C and D), to shape the contours of the subject's skin. Without being bound by this theory, it is believed that, in operation, effective cooling of the cooling device 104, which is cooled through the pipeline, depends on a number of factors. Two illustrative factors that impact the removal of heat from the skin area are the surface area of the cooling element and the temperature of the interface member. When the conduction is between two materials that are placed in physical contact, ie the skin and the cooling element, there is a certain amount of thermal resistance known as contact resistance. The contact resistance takes the form of a temperature difference between the two materials. The upper contact resistance means less effective cooling; Therefore, in the cooling device it is desirable to minimize contact resistance. One means of minimizing contact resistance and maximizing the contact surface area is with an interface member that is flexible and will conform to the natural body contours. According to alternative aspects, the contact pressure can be reduced by increasing the pressure of the applicator on the skin. The surface pressure has an additional benefit in a skin cooling application. Sufficient pressure on the skin can cause the internal capillaries to shrink, temporarily reducing blood flow in the treatment region. The reduced blood flow in the treatment area allows the area to cool to cool more efficiently and improves the effectiveness of the treatment. Thus, according to aspects of the invention, the cooling device also incorporates a flexible belt material or belt that wraps around the subject following the curvature of the cooling device. When tightening the strap, pressure is applied and can be maintained between the subject and the cooling device. According to aspects of the invention, the belt can incorporate a ring or ring through which the belt can turn to provide mechanical advantage when tightening the belt. In accordance with other aspects of the invention, the strap also incorporates Sailboat or bolt or buckle to maintain the pressure once the belt is tightened.

In operation, an operator can hold the cooling device 104 in one hand by taking the control system housing 202 or other suitable control (not shown). Then the cooling elements 302a-g can be moved or rotated to achieve a desired orientation. The operator can place the cooling device 104 having the cooling elements 302a-g in the desired orientation near the skin of the subject to remove heat from a subcutaneous region of the subject 101. In one embodiment, the operator tightens the retention devices 208a-b fixed to the cooling device 104 to apply pressure to the skin of the subject. In another embodiment, the operator can manually press the cooling device 104 against the skin of the subject. The operator can also verify and control the treatment procedure by pooling mediates, such as skin temperature, of the sensing element 710. By cooling the subcutaneous tissues to a temperature below 37 ° C, more preferably below 25 ° C, the rich cells the subcutaneous lipids can be accepted selectively. The affected cells are then reabsorbed in the patient through natural procedures. In accordance with aspects of the invention, the members of inference 418, for example thin aluminum plates, are mounted on the bottom of the thermoelectric coolers in a manner to ensure good thermal contact between the thermoelectric coolers and the interface members. The members of The interface can be coupled to the cooling element by a variety of mechanical fastening means as is known in the art. For example, the coupling means may include thermally conductive epoxy or use thermal grease such as zinc oxide. In operation, the cooling is efficiently distributed through the heat exchange elements 300a-g. For example, the cooling device includes a series of interface members 418 approximately one mm thick. The interface members 418 are thermal communication with the cooling elements 302a-g by mechanical fixation such as thermal epoxy. The cooling elements 302a-g are cooled by a plurality of thermoelectric coolers to provide a more efficient cooling system to the treatment region. The cooling elements 302a-g are contained in segments that move in relation to one another to form the contours of the skin of the subject. Alternatively, the cooling elements rotate in relation to one another, similar to the joined segments of a metal watch band, thus allowing the assembly to the curve. As assigned, the interface members and cooling elements protect the thermoelectric coolers while maintaining good heat transfer between the thermoelectric coolers and the skin. The interface members are adjusted so that they do not have a significant thermal mass. In one design, each Thermoelectric cooler could be 2.54 cm. x 3.81 cm. The interface member of the aluminum plate could also be 2.54 cm. x 3.81 cm with a thickness of 0.10 cm. If the cooling energy of the thermoelectric chillers is approximately 10W, which is appropriate based on the expected heat flow to be conducted from the skin, then the aluminum plate could be cooled from an ambient temperature of 20 ° C to a treatment temperature of -10 ° C in approximately 7 seconds. The change in the internal energy of the plate is described by the following equation: ?? =? . V. C. ?? where ?? is the change in internal energy, p is the density of material, V is the volume of material, C ° is the heat capacity of the material, and ?? It is the change of temperature. In the problem described above, the volume of the aluminum plate is V = 2.54 cm. X 3.81 cm. 0.10 cm or 0.14 cm3 (9.8 x 10-7 m3). For a typical aluminum grade, C ° = 875 J / Kg * ° C and p = 2770 Kg / m3. Solve the equation used these constants: ?? = 2770 Kg / m3 * 9.8 x 10-7m3 * 875J / Kg * ° C * 30 ° C = 71.3J If the thermoelectric coolers have a cooling power of 10W, then 71.3J would be removed from the aluminum plate in 7.1 seconds , as shown in the calculation below: 71.3 J / (10 J / second) = 7.13 seconds A small or hollow space in the frame of the skin surface can be included in one modality. Before applying the device Upon cooling to the skin, a thermal conduction fluid or coupling agent can be applied to the device and to the skin to minimize contact resistance and increase heat transfer between the cooling device and the skin. This coupling agent will fill the space in the cooling device and allow limited lateral conduction between the plates of thermoelectric coolers. This will create a uniform temperature gradient across the skin area when cooling is applied to the skin. The coupling agent can be applied to the skin or to the interface member to provide improved thermal conductivity. The coupling agent may include polypropylene glycol, polyethylene glycol, propylene glycol, and / or glycol. The glycols, glycerols, and other defrosting chemicals are efficient freezing point sedatives and act as a solute to lower the freezing point of the coupling agent. Propylene glycol (CH3CHOHCH20H) is an illustrative component of the deicer or non-freezing coupling agents. Other components include polypropylene glycol (PPG), polyethylene glycol (PEG), polyglycols, glycols, ethylene glycol, dimethyl sophoxido, polyovinylpyridine, calcium magnesium acetate, sodium acetate, and / or sodium formate. The coupling agent preferably has a freezing point in the range of -40"C to 0 ° C, more preferably below -10 ° C as further described in the Provisional Application of E.U.A., entitled Coupling Agent for use with a device. of cooling for improved heat removal of cells rich in subcutaneous lipids, filed on April 28, 2006, incorporated herein in its entirety by reference. An expected advantage of using the cooling device 104 is that cells rich in subcutaneous lipids can generally be reduced with collateral damage to lipid-rich cells in the same region. In general, lipid-rich cells can be affected at low temperatures that do not affect non-lipid-rich cells. As a result, lipid-rich cells, such as subcutaneous adipose tissue, can be affected, while other cells in the same region are generally not damaged even though non-lipid-rich cells on the surface are subject to even lower temperatures. Another expected advantage of the cooling device 104 is that it is relatively compact because the cooling device 104 can be configured as a portable device. Yet another advantage is that the cooling device can be applied to various regions of the body of the subject because the cooling elements 302a-g can be adjusted to conform to any contour of the body. Another expected advantage is that pressing the cooling device 104 against the skin of the subject, the flow of blood through the treatment region can be reduced to achieve efficient cooling. Even another advantage expected is the use of pressure by shrinking the band to restrict blood flow to the treatment region and thereby reduce heat transfer (by transports of masses). In that way, the band can not only provide a means for holding the cooling element in place, but also ensures good thermal contact between the cooling device in the skin, and also shrinks the blood flow in the region of the skin. treatment. Even another expected advantage is that the plurality of cooling elements 302a-g more efficiently remove heat from the skin compared to an individual cooling element.

E. Specially Controlled Cooling Element Profile Many skin cooling devices rely on a relatively thick piece of aluminum or other conductive material between a thermoelectric cooler or other cooling source in the skin. When a cooling device is applied to a relatively insulating material such as skin tissue, the aluminum plate becomes isothermal and maintains a constant temperature profile across the surface of the skin. The disadvantage of this design is that when the device was cooled initially, or during the thermal cycle, the thermal mass presented by the aluminum plate requires a large cooling energy. This results in increased cooling time or increased energy required from the cooling device or both. According to aspects of the invention, the cooling device has a low thermal mass that will be maintained at a constant temperature profile through the surface of the skin. In addition, according to aspects of the invention, a plurality of cooling elements are provided to allow different regions of the skin to be treated at different temperatures during a treatment session. There are some circumstances where it may be desirable to cool different regions of the skin at different temperatures for different periods of time. According to aspects of the invention, each thermoelectric cooler can be individually controlled to cool different regions of the skin at different temperatures and / or during different periods of time and / or to ensure uniform temperature throughout the treatment region. One reason why this may be desirable is that the tissue composition is different in different body locations. Some regions have thicker layers of adipose tissue than others, which influence the thermal response of the skin. In other regions, the presence of bone or other organs will affect the transfer of heat to the skin. In accordance with aspects of the invention, a spatially controlled temperature profile can provide more efficient cooling to the treatment region. The plurality of thermoelectric coolers allows the cooling device to accommodate spatial cooling. For example, the thermoelectric coolers contained in the perimeter of the cooling device may have a lower or higher temperature or duration than the thermoelectric coolers contained inside of the cooling device due to different binding conditions in the different areas of the treatment zone. In accordance with aspects of the invention, the cooling device can rapidly and efficiently cool the skin to a pre-prescribed temperature. In addition, the cooling device described herein has the additional ability to treat in a large area in an individual treatment while cooling different regions at different temperatures and / or for different durations. This variation in alternatively localized cooling would be achieved by using a cooling device that is relatively small for many treatments to be performed, cooling to different temperatures in different regions. However, this type of cooling device would require many treatments, thereby increasing the total treatment time and the opportunity for operator error. In addition, as a cooling device with a large thermal mass, a longer cooling time would be used during each treatment. According to aspects of the invention, the device can accommodate specially controlled cooling temperature profiles which can provide at least the following advantages: (1) increased efficiency; (2) decreased energy consumption with comparable efficiency; (3) increased patient comfort; or (4) decreased treatment time. For example, according to aspects of the invention, the plurality of thermoelectric coolers will allow the adjustment of anatomical differences between patients by selectively allowing or disabling pons of the apparatus based on anatomical differences of the patient. One example includes disabling thermoelectric coolers around the bone anatomy for patient comfort or for energy conservation. Alternatively, a paular pattern of controlled cooling can be adapted to fit the individual cellulite patient pattern, thereby increasing the effectiveness of the treatment. Similarly, treatment regions that require a higher intensity of treatment may be pre-identified by ultrasound or other devices. The device can then be spatially controlled to provide treatment of intensity greater than pre-identified areas. Other advantages include increased patient comfort and safety by allowing spatial control of cooling to accommodate non-natural anatomy (e.g. protuberances, spots, nipples, areas with hair, scars, wounds, presence of implants, jewelry, or increased sensitivity areas) . Another advantage of spatial control of the device includes using only a subset of the cooling elements in order to treat only the region that requires treatment. It is advantageous to use a device that can accommodate small and large treatment regions without over-treating (for example, a large device that can not be spatially controlled) or that has to move the device multiple times in that way by extending the time of treatment (for example, a treatment device smaller than the treatment region). Thus, according to aspects of the invention, a selected region of thermoelectric chillers for a few degrees hotter than another region of thermoelectric chillers can be controlled. Alternatively, a first region of the cooling device can be turned off while a second region of the cooling device is activated, so that only one region selected from the subject is treated, thereby limiting the treatment region. Other advantageously spatially controlled patterns include treatment areas within the treatment region more intensively, which conserves energy by alternating thermoelectric coolers, which increase cooling to a perimeter in order to provide a uniform cooling pattern across the treatment area, and a combination of those spatially controlled patterns in order to increase treatment efficacy, reduce treatment time, decrease energy consumption and provide comfort and safety to the patient.

F. Variable Time Cooling Profiles In certain embodiments, once the desired temperature is achieved, the temperature of the region can be maintained for a predetermined period of time. The cooling cycle can be terminated by separating the heat exchange surfaces 420a-g from the foot !. After a certain period of time, if desired, e¡ Cooling device 104 can be reapplied to the same pon of the skin as described above until the lipid-rich cells are affected in an amount sufficient to produce a desired reduction in lipid-rich cells. In another embodiment, the cooling device 104 can be applied to a different pon of the skin as described above to selectively affect lipid-rich cells in a different subcutaneous target region. Alternatively, the cooling elements 302a-g can be controlled in accordance with a predetermined variable time cooling profile for cooling, heating, re-cooling, and / or cooling in a temperature pattern in steps with time. In paular, according to aspects of the invention, the controlled cooling patterns with time provide at least the following advantages: (1) increased efficiency; (2) decreased energy consumption with comparable efficiency; (3) increased patient comfort; or (4) decreased treatment time. An illustrative cooling pattern includes cooling to -5 degrees for 15 minutes, heating to 30 ° for 5 minutes, cooling to -3 ° for 10 minutes. In accordance with aspects of the present invention, any desired variable time cooling profile can be programmed into the device. For example, a gradual or stepped cooling rate can decrease energy requirements. Alternatively, a rapid cooling rate can be used in order to super cool the region of treatment. Exemplary cooling rates include 5 to 1000 degrees per minute, more preferably 30 to 120 degrees per minute, and most preferably 35 to 100 degrees per minute. An expected advantage of controlling the time temperature profile of the device is that in practice, the tissue is sensitive to cooling rates and thus tissue damage can be controlled by controlling the cooling rate of the treatment region. In addition, cooling the treatment region for an extended period of time, or in phases, will increase patient comfort. Another expected advantage of the various embodiments described above is that the cooling device 104 can selectively reduce cell-rich subcutaneous lipids without unacceptably affecting the dermis, epidermis, and / or other tissues. Another expected advantage is that the cooling device 104 can selectively simultaneously reduce subcutaneous lipid-rich cells while providing beneficial effects to the dermis and / or epidermis. These defects may include: Fibroplasia, neocolagenesis, collagen contraction, collagen compaction, increased collagen density, collagen remodeling, and acanthosis (epidermal thickening). In the treatment of cellulite, it is expected that the dermal thickening on the lobes of superficial hernia fats help to reduce the appearance of cellulite and improve the longevity of the effect. Another expected advantage is that the cooling device 104 can form several contours of body of a subject by rotating or moving the cooling elements 302a-g to achieve a desired orientation. Even another expected advantage is that the cooling device 104 can be configured as a portable device to facilitate the operation. In addition, another expected advantage is that the system 100 with the portable cooling device 104 and the ongoing mounted processing unit 114 and cooling unit 106 are compact and efficient so that the method described above can be administered in an outpatient clinic or the doctor's office instead of the hospital. Yet another expected advantage is that the cooling device 104 can be tied in place to release the doctor's hands and allow the physician to do other tasks with the treatment in this procedure.

G. Method for Applying Cooling Devices with a Plurality of Rotating or Movable Cooling Elements In operation, the angle between the heat exchange surface 420 is selected when rotating or moving the cooling elements 302a-g. the angle between the cooling elements 320a-g is frequently selected to conform the heat exchange surfaces 320a-g to various contours of the body of the subject 101 and / or a desired actuating arrangement. In the embodiment shown in Figure 2A, the angle between the heat exchange surface 320a-g may be generally 180 °, that is, the heat exchange surface 320a-g are generally coplanas to apply the cooling device to a treatment region. In the embodiment shown in Figure 2B, the angle may be less than 180 ° to allow the cooling device to hang over a body of the subject. In the embodiment shown in Figure 2C, the cooling device further curves to conform to the body of the subject. In other embodiments, the angle can be any angle to conform to the body of a subject, as would be recognized by one skilled in the art. After configuring the cooling elements 302a-g, an operator takes the cooling device 104 close to the skin of the subject 101. In the embodiment shown in Figure 2A (where the angle is in a generally flat configuration), the elements Cooling 302a-g initially are placed flat against the skin of the subject. The operator then rotates or moves the cooling device to conform to the body of a subject. The cooling device can be adjusted by a strap, and a pressure can be increased by adjusting the belt in addition. Optionally, the pressure sensor can be used to sense the applied pressure of pressure across the interface members 418, and the perceived force of force can be processed by the processing unit 114 and presented to the output device 120. The pressure can then adjust based on the values presented. Depending on the location of the cooling device, the pressure, for example, may be higher than the systolic pressure in the skin to prevent or block the flow of blood in the treatment region. Applying such pressure allows more effective increase of the target region because there is less blood flow to transfer heat from the body of the nucleus to the treatment region. Applying pressure cooling to the subject's skin or pressing against the skin can be advantageous for efficient cooling. In general, subject 101 has a body temperature of about 37 ° C, and blood circulation is a mechanism to maintain a constant body temperature. As a result, the flow of blood through the dermis and the subcutaneous layer of the region is a source of heat that counteracts the cooling of subdermal fat. As such, if the blood flow is not reduced, the cooling of the subcutaneous tissues would require not only the removal of specific heat from the tissues but also from the blood circulating through the tissues. In this way, reducing or eliminating blood flow through the treatment region can improve the cooling efficiency and edit excessive heat loss of the dermis and epidermis. By cooling subcutaneous tissues to a temperature below 37 ° C, cells rich in subcutaneous lipids can be selectively affected. In general, the epidermis and dermis of subject 101 have lower amounts of unsaturated fatty acids compared to cells rich in important lipids that form subcutaneous tissues. Because non-lipid-rich cells can usually withstand colder temperatures better than Lipid-rich cells, cells rich in subcutaneous lipids can be selectively affected while maintaining non-lipid-rich cells in the dermis and epidermis. An illustrative range for cooling elements 302a-g may be from about -20 ° C to about 20 ° C, preferably from about -20 ° C to about 10 ° C, more preferably from about -15 ° C to about 5 ° C. C, more preferably from about -10 ° C to about 0 ° C. The lipid-rich cells can be affected by interrupting, agitating, disabling, destroying, removing, killing, or otherwise altering. Unbound theoretically, lipid-rich cells that are selectively affected are believed to result from localized crystallization of highly saturated fatty acids at temperatures that do not induce crystallization in non-lipid-rich cells. The crystals can break down the double layer membrane of the lipid-rich cells to selectively gangrelate these cells. In that way, damage of non-lipid-rich cells, such as skin cells, can be avoided at temperatures that induce crystal formation in lipid-rich cells. Cooling is also believed to induce lipolysis (eg, fat metabolism) of lipid-rich cells to further increase the reduction in cells rich in subcutaneous lipids. Lipolysis can be increased by local fiber exposure, which induces stimulation of the sympathetic nervous system.

H. Computer System Software Modules Figure 11 is a functional diagram showing illustrative software modules 940 suitable for use in the processing unit 114. Each component may be a computer program, procedure, or procedure written as a bridge code in a conventional programming language, such as the C ++ programming language, and may be presented for execution by the processor CPU 942. The various implementations of the source and object code and byte codes may be stored in a readable storage medium. by computer or represented in a transmission medium on a carrier wave. The processor modules 942 may include an input module 944, a database module 946, a procedure module 948, an output module 950, and, optionally, a presentation module 951. In another embodiment, the modules of Software 940 can be presented for execution by the CPU of a network server in a distributed computing scheme. In operation, the input module 944 accepts an operator input, such as procedure starting point and control selections, and communicates the accepted information or selects other components for further processing. Database module 946 organizes records, which include 954 for operation meters, 956 operator activities, and 958 alarms, and facilitates the storage and retrieval of these records to and from a 952 database. database it can be used, including a flat file system, hierarchical database, relationship database, or distributed database, as provided by a database vendor such as Oracle Corporation Shores, California. The procedure module 948 generates control variables based on sensor readings 960, and the output module 950 generates output signals 962 based on the control variables. For example, the output module 950 can convert the control variables generated from the procedure module 948 into 4-20 mA 962 output signals suitable for a direct current voltage modulator. The processor 942 may optionally include the display module 951 to display, print, or download the sensor readings 960 and output signals 962 through devices for the such as the output device 120. The appropriate display module 951 may be a video controller that allows the processor 942 to display the readings of the sensor 960 on the output device 120. Unless the contact clearly requires otherwise through the description and the claims, the words "comprise", "that they comprise ", and similar ones that interpret the inclusive sense with the opposite to an exclusive or exhaustive sense; that is, in a sense "that includes, but is not limited to". Words that use the singular or plural number also influence the plural or singular number, respectively. When the claims use the word "or" in reference to a list of Two or more articles, this word covers all the following interpretations of the word: any of the items on the list. All items on the list, and any combination of items on the list. The above detailed descriptions of embodiments of the invention are not intended to be exhaustive or to limit the invention to the precise form described above. While the specific embodiments of, and examples for, the invention are described above for illustrative purposes, several equivalent modifications are possible within the scope of the invention, as will be recognized by those skilled in the art. For example, while the steps are presented in a given order, alternative modes can perform steps in a different order. The various embodiments described herein may be combined to provide other modalities. In general, the terms used in the following claims should not be construed as limiting the invention to the specific embodiments described in the specification, unless the foregoing detailed description explicitly defines such terms. While certain aspects of the invention are presented below in certain claimed forms, the inventors contemplate the various aspects of the invention in any number of claimed forms. Accordingly, the inventors reserve the right to add additional claims after completing the application to pursue such forms of claims additional for other aspects of the invention. The various embodiments described above can be combined to provide other modalities. All US patents, US patent application publications, US patent applications, foreign patents, foreign patent applications and non-patent publications named in this specification and / or listed in the Application Data Sheet are incorporated herein. by reference as a whole. Aspects of the invention may be modified, if necessary, by employing cooling devices with a plurality of cooling elements, thermally conductive devices with various configurations, and concepts of the various patents, applications, and publications to provide even other embodiments of the invention. . These and other changes can be made to the invention in view of the above detailed description. In general, in the following claims, the terms used should not be construed to limit the invention to the specific embodiments described in the specification and the claims, should not be construed to include all of the cooling that operates in accordance with the claims. Accordingly, the invention is not limited by the description, instead its scope will be fully determined by the following claims.

Claims (25)

1. A cooling device for removing heat from subcutaneous lipid-rich cells of a subject having skin, comprising: a plurality of cooling elements hinged to each other to allow the elements to rotate in relation to one another; and wherein the cooling elements have a skin surface.

2. The cooling device according to claim 1, wherein the angle between the cooling elements can be rotated from about 0o to about 45 °.

3. The cooling device according to claim 1, wherein the cooling device forms an arcuate shape configured to conform to a subject.

4. The cooling device according to claim 1, further comprising a retaining device for releasably retaining the cooling device in a subject.

5. - The cooling device according to claim 1, wherein the cooling elements further comprise a fluid chamber in thermal communication with the interface members and a plurality of fluid ports in fluid communication with the fluid chamber, and wherein the fluid ports are configured to allow fluid to circulate through the fluid chamber.

6. - The cooling device according to claim 5, wherein the fluid in communication with the fluid chamber circulates through a device that freezes the fluid.

7. The cooling device according to claim 5, wherein the fluid chambers are serpentine-shaped.

8. The cooling device according to claim 5, wherein the cooling elements are connected fluidly in series.

9. - The cooling device according to claim 1, further comprising a thermally conductive coupling agent applied to an interface between the cooling device and the skin of the subject to increase the thermal conductivity between the cooling device and the skin of the subject.

10. - The cooling device according to claim 1, wherein each of the plurality of cooling elements has a first side in thermal communication with the corresponding interface member and a second side opposite the first side in thermal communication with the corresponding thermoelectric heat exchanger, wherein the cooling element is configured to reduce a temperature of the target region so that the lipid-rich cells in the region are affected while non-lipid-rich cells near the heat exchange surface are not significantly affected.

11. - The cooling device according to claim 1, further comprising a sensing element near at least one of the interface members.

12. - The cooling device according to claim 1, further comprising: a first temperature sensing element near at least one of the interface members for detecting a temperature of a corresponding interface member; and a second temperature sensing element near at least one of the interface members to detect a temperature of the subject's skin.

13. - The cooling device according to claim 1, wherein the hinge is a live hinge.

14. A system for removing heat from subcutaneous lipid rich cells, comprising: a plurality of rotatable cooling elements that move in relation to one another and thermally coupled to a plurality of thermoelectric cooling devices and a corresponding plurality of elements of heat exchange contained in a rotatable segmented frame and configured to reduce a temperature of a target region under the subject's epidermis to reduce the temperature of lipid-rich cells in the region so that the lipid-rich cells are affected Substantially, as long as the cells not rich in lipids in the epidermis are not substantially affected; and a fluid chamber fluidly coupled to the cooling device to dissipate the heat generated by the cooling device.

15. The system according to claim 14, further comprising a cooling unit in thermal communication with the fluid chamber and configured to provide a cooler to the cooling device.

16. The system according to claim 15, further comprising a fluid line between the cooling unit and the cooling device so that the cooling device is in fluid communication with the cooling unit.

17. The system according to claim 15, wherein the cooling device further comprises a sensing element near at least one of the heat exchange surfaces, and wherein the system further comprises: a processor in electrical communication with the perception element and configured to convert electrical signals of the perception element into an operation parameter; and a database electrically connected to the processor to store the operation parameter.

18. The system according to claim 17, wherein the processor includes a control module for controlling the temperature of the region based on the operation parameter, wherein the temperature of the region is controlled based on a selected spatial temperature profile.

19. - The system according to claim 17, wherein the processor includes a control module for controlling the temperature of the region based on the operation parameter, and wherein the temperature of the region is controlled based on a profile of predetermined variable time.

20. - A cooling device for removing heat from lipid-rich cells of a subject having skin, said device comprising: a plurality of cooling elements, each of said cooling element moving in relation to an adjacent cooling element , wherein said cooling device is comfortable to the subject's skin.

21. - The cooling device according to claim 20, wherein said cooling elements have edges, wherein the edges of adjacent cooling elements remain substantially parallel to one another.

22. - The cooling device according to claim 20, wherein said cooling elements rotate with respect to a plane in at least one direction.

23. - The cooling device according to claim 20, wherein said cooling elements are thermoelectric cooling elements.

24. - The cooling device according to claim 20, further comprising a flexible substrate, wherein said plurality of cooling elements is fixedly arranged on said substrate.

25. - The cooling device according to claim 20, wherein each of said plurality of cooling elements is positioned adjacent to at least one other cooling element and hingedly joins the adjacent cooling element.